DSMT Reimbursement Tips
Sponsoring organization must have an NPI number as well as be enrolled as a Medicare provider for services other than DSM
NPI application forms: https://nppes.cms.hhs.gov or for paper application, call 800-465-3203.
If new to Medicare, need to submit Form 855I to enroll as a Medicare provider (obtain forms through local Medicare Administrative Contractor (MAC))
DME/Pharmacy providers must also enroll as a Part B provider to bill for DSMT service
Must submit notice of AADE accreditation to local Medicare Administrative Contractor (MAC)
Confirm that the HCPCS codes for billing DSMT are loaded in billing system (G0108 and G0109)
Submit accreditation notice to contracted commercial payers and verify that DSMT codes G0108 and G0109 are included in contract.
If off-site locations are added to accredited program, follow process and recommended steps included on AADE website.
Consider purchasing reimbursement resources such as AADE’s “Navigating the Maze: Overcoming the Obstacles to Reimbursement for Diabetes Self-management”
Members of AADE can seek additional information from the AADE “Reimbursement Expert” located in our Member Center. Please review the FAQs first because your question may have already been answered.
AADE has policies and procedures relating to the Diabetes Education Accreditation Program. The policies provide specific information that help to clarify aspects of the various requirements and processes relating to such issues as site visits, reaccreditation, appeals and complaints.
AADE accredited programs have access to tools that allow diabetes education programs to track and report their patients' behavior change and clinical indicators.
Based upon the AADE7 Self-Care Behaviors framework, the curriculum supports diabetes educators in their efforts to help people with diabetes and related conditions learn to make daily decisions about self-care that will have a positive impact on their clinical outcomes and overall health status.
Download the Physician Referral Form:
The Diabetes Services Order Form is available in an electronic format.
Confused by a term? Review our glossary of accreditation terms.
- Pub 100-02 Medicare Benefit Policy Transmittal 109 CR 6510
- The DSMT Rule and Reimbursement
- Section 4105 of the Balanced Budget Federal Register Act of 1997 Permits Medicare Coverage of Diabetes
- Federal Register Approval - Feb 2009
- Clarification of National Standards Permitting Qualified RDs, RNs, or Pharmacists to Individually Furnish Diabetes Self-Management Training Services